Medical lessons learned on battlefield may help after Boston Marathon

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Two bomb blasts that ripped through the finish line area at Monday's Boston Marathon have caused mayhem and injuries similar to those seen on the battlefields of Iraq and Afghanistan, military hospital experts said.

The blasts killed three people and injured more than 170. Some of the injuries include broken bones, amputated limbs and head wounds.

People who witnessed the explosions but escaped injury could also be affected with acute stress in the first few days and post-traumatic stress disorder in the long term, experts said.

The Army has learned several big lessons from the past 11 years during the wars in Iraq and Afghanistan, and those are being applied to the situation in Boston, Lt. Col. Brian Sonka, a surgeon and trauma medical director at William Beaumont Army Medical Center in El Paso, Texas said.

"In the past 10 years, there has been a revolution in the way we manage massive hemorrhaging," Sonka said.

The new method, called hemostatic resuscitation, started with work done at the Ibn Sina hospital in Iraq and now, it has become common practice, Sonka said. Simply put, patients are given transfusions of clotting agents much earlier than they used to be.

"If you picked up textbooks even from 2005, they don't mention that stuff," Sonka said.

Additionally, doctors now view tourniquets, which had a bad reputation from the Vietnam War, as a major help in preventing massive blood loss and shock.

"They buy time until they can get to the hospital," Sonka said.

Lt. Col. Kenneth Nelson, an orthopedic trauma surgeon at Beaumont, called the situation in Boston horrific.

"But they got fabulous medical centers in Boston and great doctors," Nelson said. "I doubt they routinely take care of blast injuries, but they routinely take care of trauma like car accidents, falls from heights. There's a lot of similarities. They are also familiar with the research that's being done with war wounded," Nelson said.

All of that is available through research published by Walter Reed and Brooke Army medical centers, Nelson said.

Col. Dale Levandowski is a psychiatrist and chief of the Department of Behavioral Health at Beaumont.

The injuries sustained by runners and spectators at Boston are similar to what a small Army unit receives when it is out on patrol and detonates an improvised explosive devise or homemade bomb.

"It's a very, very small percentage that die from blast injuries, because we have such good care capabilities even in a deployed environment," said Levandowski, who has deployed twice  once to Iraq in 2005-06 and to Afghanistan in 2010. "However, the issue goes downstream in terms of rehabilitation and the quality of life for those who have suffered blast injuries."

People who have lost limbs, for instance, face the challenge and struggle to find new meaning in their lives, he said.

Those who witnessed the event in person also could be at risk of developing acute stress during the first month after such a traumatic experience, Levandowski said.They have experienced "intense fear or horror."

Normal reactions in the initial days after witnessing such an event include having recurring thoughts of it, feeling like it's surreal, or that it's detached from them and having nightmares.

"It's just our bodies" and heads' way of making sense out of something that is incredible and out of the normal range of experience," he said.

Those are all normal responses and 75 to 80 percent of people see those symptoms diminish within a month, Levandowski said.

But for 15 to 20 percent, they develop what is called post-traumatic stress disorder. They experience persistent nightmares, are hyper-vigilant against possible threats and avoid loud places that may remind them of the incident.

Medicine and the Army also have made advances in dealing with post-traumatic stress disorder through a variety of therapies, Levandowski said. These include ways of mastering emotions and thoughts that are associated with the trauma.

Louisiana National Guard Staff Sgt. Steven W. Williams, 40, of Denham Springs, La., suffered a severe back injury while serving in Iraq and deals with post-traumatic stress disorder. He lives in El Paso and has been getting treatment through the Warrior Transition Battalion at Fort Bliss.

Like many Americans, Williams said he had a hard time processing what he saw during the Boston Marathon.

"First thing I thought of, we train for those kind of situations," Williams said. "It was unique to see it on American soil. It's kind of a shock. We knew it would happen again (after 9/11) but we didn't know when, where or how."

Those who were injured can expect their recovery to be slow and tedious, Williams said.

The injured and emergency responders also should seek some form of counseling sooner rather than later, Williams advised, to lessen future problems.

David Burge is a reporter for the El Paso Times 

5-year-old among Boston Medical blast patients

The trauma surgery chief at Boston Medical Center says a 5-year-old is among the 19 patients still being treated there for injures received during the marathon bombings and that all are expected to survive.

Dr. Peter Burke said Wednesday morning that the hospital treated 23 people following the blasts. He said two patients, including the 5-year-old, remain critical, but that all patients are making progress.

"We have a lot of lower extremity injuries, so I think the damage was low to the ground and wasn't up," he said. "The patients who do have head injuries were blown into things or were hit by fragments that went up."

Dozens of patients have been released from hospitals around the Boston area.

Massachusetts General Hospital spokeswoman Katie Marquedant said all but 12 of the 31 people sent there have been released. Eight are still in critical condition.

Brigham and Women's Hospital still has 15 of its original 31 patients, and reported that five are in critical condition. A spokesman there could not say how many patients had been released and how many had been transferred to other facilities.

Beth Israel Deaconess Medical Center still has 13 of the 24 people originally sent there. Boston Children's Hospital has released seven of its original 10 patient. The three remaining are all children. A 2-year-old boy with a head injury is in good condition; a 10-year-old boy with multiple leg injuries is in critical condition and a 9-year-old girl with a leg injury also is in critical condition.

Tufts Medical Center has released half of its 14 bombing patients.

There were 27 patients who were treated and released from St. Elizabeth's, Carney Hospital, and Norwood Hospital.

 The Associated Press

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